Nonbacterial thrombotic endocarditis

Nonbacterial thrombotic endocarditis
Other names: Marantic endocarditis[1]
a,b) Transthoracic echocardiography - NBTE arrow c.d) after anticoagulation therapy lesion practically disappeared
Specialty	Cardiology
Symptoms	Typically no symptoms[1]
Complications	Stroke[1]
Causes	Platelet and fibrin emboli attached to heart valves[2]
Risk factors	Cancer[1]
Diagnostic method	Echocardiography[1]
Treatment	No effective treatment, anticoagulation[1]

Nonbacterial thrombotic endocarditis (NBTE) is a form of inflammation of the heart in which small sterile vegetations are deposited on the valves.^[3] There are typically no symptoms, but has the possibility of presenting with symptoms of stroke.^[1]

It is caused by small platelet and fibrin emboli attached to the heart valves.^[2]

Diagnosis may be made by echocardiography; however not all emboli are obvious.^[1] There is no effective treatment, but anticoagulation is often used.^[1]

Around one in five people with a cancer have a non-infective emboli on a mitral or aortic valve.^[1] The condition was first identified in 1888 by Zeigler.^[3]

Signs and symptoms

There are typically no symptoms, but has the possibility of presenting with symptoms of stroke.^[1]

Risk factors

The vegetations are often associated with previous rheumatic fever. Other risk factors include:

• hypercoagulable states
• malignant cancers, especially mucin-producing adenocarcinomas (most commonly associated with pancreatic adenocarcinomas)
• systemic lupus erythematosus: Referred to as Libman-Sacks endocarditis
• trauma (e.g., catheters)

Histopathology

Grossly, vegetations form along lines of valve closure and are generally symmetric with a smooth or warty texture.^[1] Histologically, lesions are composed of fibrin (eosinophilic) and platelets but, unlike bacterial etiologies, contain little evidence of PMNs, microorganisms or inflammation.

Diagnosis

Due to the non-invasive nature of NBTE, clinical examination may or may not reveal a new murmur. An embolic stroke may be the first feature to suggest diagnosis of NBTE.^[1] An echocardiograph may be used to further assess for valvular lesions.^[1]

Treatment

There is no effective treatment, but anticoagulation is often used.^[1]

Epidemiology

Around one in five people with a cancer have a non-infective emboli on a mitral or aortic valve.^[1]

History

It was formerly known as marantic endocarditis, which comes from the Greek marantikos, meaning "wasting away".^[4] The condition was first identified in 1888 by Zeigler.^[3]

References

External links